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Koh CC, Neves EGA, de Souza-Silva TG, Carvalho AC, Pinto CHR, Sobreira Galdino A, Gollob KJ, Dutra WO. Cytokine Networks as Targets for Preventing and Controlling Chagas Heart Disease. Pathogens 2023; 12:171. [PMID: 36839443 PMCID: PMC9966322 DOI: 10.3390/pathogens12020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Chagas disease, a neglected disease caused by the protozoan Trypanosoma cruzi, is endemic in 21 Latin American countries, affecting 6-8 million people. Increasing numbers of Chagas disease cases have also been reported in non-endemic countries due to migration, contamination via blood transfusions or organ transplantation, characterizing Chagas as an emerging disease in such regions. While most individuals in the chronic phase of Chagas disease remain in an asymptomatic clinical form named indeterminate, approximately 30% of the patients develop a cardiomyopathy that is amongst the deadliest cardiopathies known. The clinical distinctions between the indeterminate and the cardiac clinical forms are associated with different immune responses mediated by innate and adaptive cells. In this review, we present a collection of studies focusing on the human disease, discussing several aspects that demonstrate the association between chemokines, cytokines, and cytotoxic molecules with the distinct clinical outcomes of human infection with Trypanosoma cruzi. In addition, we discuss the role of gene polymorphisms in the transcriptional control of these immunoregulatory molecules. Finally, we discuss the potential application of cytokine expression and gene polymorphisms as markers of susceptibility to developing the severe form of Chagas disease, and as targets for disease control.
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Affiliation(s)
- Carolina Cattoni Koh
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Eula G. A. Neves
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Thaiany Goulart de Souza-Silva
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Ana Carolina Carvalho
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Cecília Horta Ramalho Pinto
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Alexsandro Sobreira Galdino
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei (UFSJ), Campus Centro Oeste, Divinópolis 35501-296, MG, Brazil
| | - Kenneth J. Gollob
- Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil
- Instituto Nacional de Ciências e Tecnologia em Doenças Tropicais, INCT-DT, Salvador 40110-160, BA, Brazil
| | - Walderez Ornelas Dutra
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
- Instituto Nacional de Ciências e Tecnologia em Doenças Tropicais, INCT-DT, Salvador 40110-160, BA, Brazil
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Acosta-Herrera M, Strauss M, Casares-Marfil D, Martín J. Genomic medicine in Chagas disease. Acta Trop 2019; 197:105062. [PMID: 31201776 DOI: 10.1016/j.actatropica.2019.105062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/11/2019] [Indexed: 02/07/2023]
Abstract
Genetic approaches have been proposed for improving the understanding of the causes of differential susceptibility to Trypanosoma cruzi infection and Chagas disease outcome. Polymorphisms in genes involved in the immune/inflammatory response are being studied in order to clarify their possible role in the occurrence or severity of the cardiac and/or gastrointestinal complications. However still today, the number of significant associated genes is limited and the pathophysiological mechanisms underlying this condition are unknown. This article review the information currently available from the published scientific literature regarding the genetic variants of molecules of the immune system and other variants that can contribute to the clinical presentation of the disease. Genomic medicine will improve our knowledge about the molecular basis of Chagas disease, will open new avenues for developing biomarkers of disease progression, new therapeutic strategies to suit the requirements of individual patients, and will contribute to the control of one of the infections with the greatest socio-economic impact in the Americas.
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Chevillard C, Nunes JPS, Frade AF, Almeida RR, Pandey RP, Nascimento MS, Kalil J, Cunha-Neto E. Disease Tolerance and Pathogen Resistance Genes May Underlie Trypanosoma cruzi Persistence and Differential Progression to Chagas Disease Cardiomyopathy. Front Immunol 2018; 9:2791. [PMID: 30559742 PMCID: PMC6286977 DOI: 10.3389/fimmu.2018.02791] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/13/2018] [Indexed: 01/01/2023] Open
Abstract
Chagas disease is caused by infection with the protozoan Trypanosoma cruzi and affects over 8 million people worldwide. In spite of a powerful innate and adaptive immune response in acute infection, the parasite evades eradication, leading to a chronic persistent infection with low parasitism. Chronically infected subjects display differential patterns of disease progression. While 30% develop chronic Chagas disease cardiomyopathy (CCC)—a severe inflammatory dilated cardiomyopathy—decades after infection, 60% of the patients remain disease-free, in the asymptomatic/indeterminate (ASY) form, and 10% develop gastrointestinal disease. Infection of genetically deficient mice provided a map of genes relevant for resistance to T. cruzi infection, leading to the identification of multiple genes linked to survival to infection. These include pathogen resistance genes (PRG) needed for intracellular parasite destruction, and genes involved in disease tolerance (protection against tissue damage and acute phase death—DTG). All identified DTGs were found to directly or indirectly inhibit IFN-γ production or Th1 differentiation. We hypothesize that the absolute need for DTG to control potentially lethal IFN-γ PRG activity leads to T. cruzi persistence and establishment of chronic infection. IFN-γ production is higher in CCC than ASY patients, and is the most highly expressed cytokine in CCC hearts. Key DTGs that downmodulate IFN-γ, like IL-10, and Ebi3/IL27p28, are higher in ASY patients. Polymorphisms in PRG and DTG are associated with differential disease progression. We thus hypothesize that ASY patients are disease tolerant, while an imbalance of DTG and IFN-γ PRG activity leads to the inflammatory heart damage of CCC.
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Affiliation(s)
| | - João Paulo Silva Nunes
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil
| | - Amanda Farage Frade
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.,Department of Bioengineering, Brazil University, São Paulo, Brazil
| | - Rafael Ribeiro Almeida
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil
| | - Ramendra Pati Pandey
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil
| | - Marilda Savóia Nascimento
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil
| | - Jorge Kalil
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil
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4
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Alvarado-Arnez LE, Batista AM, Alves SM, Melo G, Lorena VMBD, Cardoso CC, Pereira IR, Carrazzone C, Pacheco AG, Oliveira W, Moraes MO, Lannes-Vieira J. Single nucleotide polymorphisms of cytokine-related genes and association with clinical outcome in a Chagas disease case-control study from Brazil. Mem Inst Oswaldo Cruz 2018; 113:e170489. [PMID: 29768622 PMCID: PMC5961924 DOI: 10.1590/0074-02760170489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/05/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The severity of chronic chagasic cardiomyopathy (CCC), the most frequent clinical outcome of Chagas disease (CD), has been associated with cytokine-enriched heart tissue inflammation, and high serum levels of transforming growth factor (TGFβ), interferon-gamma (IFNγ), and tumour necrosis factor (TNF). Conversely, increased interleukin (IL)-10 serum concentrations have been associated with asymptomatic CD. Cytokines and cytokine-related gene polymorphisms may control cytokine expression and have been proposed to contribute to CCC outcomes. OBJECTIVES We evaluated the association of 13 cytokine-related genes (TGFB: rs8179181, rs8105161, rs1800469; IL10: rs1800890, rs1800871, rs1800896; IFNG: rs2430561; TNF: rs1800629; BAT1: rs3853601; LTA: rs909253, rs2239704; TNFR1: rs767455; TNFR2: rs1061624) with risk and progression of CCC. FINDINGS Four hundred and six seropositive patients from CD endemic areas in the state of Pernambuco, north-eastern Brazil, were classified as non-cardiopathic (A, 110) or cardiopathic (mild, B1, 163; severe, C, 133). We found no evidence of TGFB, IL10, TNF, or TNFR1/2 gene polymorphisms associated with CCC risk or progression. Only BAT1 rs3853601 −22G carriers (B1 vs. C: OR = 0.5; p-value = 0.03) and IFNG rs2430561 +874AT (A vs. C: OR = 0.7; p-value = 0.03; A vs. B1+C: OR = 0.8; p-value = 0.02) showed a significant association with protection from cardiopathy in a logistic regression analysis with adjustment for gender and ethnicity; however, the association disappeared after performing adjustment for multiple testing. A systematic review of TNF rs1800629 −308G>A publications included five studies for meta-analysis (534 CCC and 472 asymptomatic patients) and showed no consensus in pooled odds ratio (OR) estimates for A allele or A carriers (OR = 1.4 and 1.5; p-values = 0.14 and 0.15, respectively). In CD patients, TNF serum levels were increased, but not affected by the TNF rs1800629 −308A allele. MAIN CONCLUSIONS Our data suggest no significant contribution of the analysed gene variants of cytokine-related molecules to development/severity of Chagas' heart disease, reinforcing the idea that parasite/host interplay is critical to CD outcomes.
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Affiliation(s)
- Lucia Elena Alvarado-Arnez
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia das Interações, Rio de Janeiro, RJ, Brasil
| | - Angelica Martins Batista
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia das Interações, Rio de Janeiro, RJ, Brasil
| | - Silvia Marinho Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico de Pernambuco, Recife, PE, Brasil
| | - Gloria Melo
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico de Pernambuco, Recife, PE, Brasil
| | - Virgínia Maria Barros de Lorena
- Fundação Oswaldo Cruz-Fiocruz, Instituto Aggeu Magalhães, Departamento de Imunologia, Laboratório de Imunoparasitologia, Recife, PE, Brasil
| | - Cynthia C Cardoso
- Universidade Federal do Rio de Janeiro, Instituto de Biologia, Departamento de Genética, Laboratório de Virologia Molecular, Rio de Janeiro, RJ, Brasil
| | - Isabela Resende Pereira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia das Interações, Rio de Janeiro, RJ, Brasil
| | - Cristina Carrazzone
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico de Pernambuco, Recife, PE, Brasil
| | - Antonio G Pacheco
- Fundação Oswaldo Cruz-Fiocruz, Programa de Computação Científica, Rio de Janeiro, RJ, Brasil
| | - Wilson Oliveira
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico de Pernambuco, Recife, PE, Brasil
| | - Milton Ozório Moraes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Joseli Lannes-Vieira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia das Interações, Rio de Janeiro, RJ, Brasil
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Fu KYJ, Zamudio R, Henderson-Frost J, Almuedo A, Steinberg H, Clipman SJ, Duran G, Marcus R, Crawford T, Alyesh D, Colanzi R, Flores J, Gilman RH, Bern C. Association of caspase-1 polymorphisms with Chagas cardiomyopathy among individuals in Santa Cruz, Bolivia. Rev Soc Bras Med Trop 2017; 50:516-523. [PMID: 28954073 DOI: 10.1590/0037-8682-0015-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/16/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION: Trypanosoma cruzi (Tc) infection is usually acquired in childhood in endemic areas, leading to Chagas disease, which progresses to Chagas cardiomyopathy in 20-30% of infected individuals over decades. The pathogenesis of Chagas cardiomyopathy involves the host inflammatory response to T. cruzi, in which upstream caspase-1 activation prompts the cascade of inflammatory chemokines/cytokines, cardiac remodeling, and myocardial dysfunction. The aim of the present study was to examine the association of two caspase-1 single nucleotide polymorphisms (SNPs) with cardiomyopathy. METHODS: We recruited infected (Tc+, n = 149) and uninfected (Tc-, n = 87) participants in a hospital in Santa Cruz, Bolivia. Cardiac status was classified (I, II, III, IV) based on Chagas cardiomyopathy-associated electrocardiogram findings and ejection fractions on echocardiogram. Genotypes were determined using Taqman probes via reverse transcription-polymerase chain reaction of peripheral blood DNA. Genotype frequencies were analyzed according to three inheritance patterns (dominant, recessive, additive) using logistic regression adjusted for age and sex. RESULTS: The AA allele for the caspase-1 SNP rs501192 was more frequent in Tc+ cardiomyopathy (classes II, III, IV) patients compared to those with a normal cardiac status (class I) [odds ratio (OR) = -2.18, p = 0.117]. This trend approached statistical significant considering only Tc+ patients in class I and II (OR = -2.64, p = 0.064). CONCLUSIONS: Caspase-1 polymorphisms may play a role in Chagas cardiomyopathy development and could serve as markers to identify individuals at higher risk for priority treatment.
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Affiliation(s)
- Katherine Yih-Jia Fu
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Roxana Zamudio
- Department of Genetics, University of Leicester, Leicester, United Kingdom
| | - Jo Henderson-Frost
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Alex Almuedo
- Fundació Hospital de Granollers, Granollers, Barcelona, Spain
| | - Hannah Steinberg
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Steven Joseph Clipman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gustavo Duran
- Hospital San Juan de Dios, Santa Cruz de la Sierra, Bolivia
| | - Rachel Marcus
- MedStar Washington Hospital Center, Washington, District of Columbia, United States of America
| | - Thomas Crawford
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Daniel Alyesh
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rony Colanzi
- Hospital Japones, Santa Cruz de la Sierra, Bolivia
| | - Jorge Flores
- Hospital San Juan de Dios, Santa Cruz de la Sierra, Bolivia
| | - Robert Hugh Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, United States of America
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Teixeira TL, Machado FC, Alves da Silva A, Teixeira SC, Borges BC, Dos Santos MA, Martins FA, Brígido PC, Rodrigues AA, Notário AFO, Ferreira BA, Servato JPS, Deconte SR, Lopes DS, Ávila VMR, Araújo FDA, Tomiosso TC, Silva MJB, da Silva CV. Trypanosoma cruzi P21: a potential novel target for chagasic cardiomyopathy therapy. Sci Rep 2015; 5:16877. [PMID: 26574156 PMCID: PMC4648062 DOI: 10.1038/srep16877] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 10/21/2015] [Indexed: 11/09/2022] Open
Abstract
Chagas disease, which is caused by the parasite Trypanosoma cruzi, is an important cause of cardiomyopathy in Latin America. It is estimated that 10%–30% of all infected individuals will acquire chronic chagasic cardiomyopathy (CCC). The etiology of CCC is multifactorial and involves parasite genotype, host genetic polymorphisms, immune response, signaling pathways and autoimmune progression. Herein we verified the impact of the recombinant form of P21 (rP21), a secreted T. cruzi protein involved in host cell invasion, on progression of inflammatory process in a polyester sponge-induced inflammation model. Results indicated that rP21 can recruit immune cells induce myeloperoxidase and IL-4 production and decrease blood vessels formation compared to controls in vitro and in vivo. In conclusion, T. cruzi P21 may be a potential target for the development of P21 antagonist compounds to treat chagasic cardiomyopathy.
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Affiliation(s)
- Thaise Lara Teixeira
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | - Fabrício Castro Machado
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil.,Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, SP, Brasil
| | - Aline Alves da Silva
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | - Samuel Cota Teixeira
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | | | | | - Flávia Alves Martins
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | | | - Adele Aud Rodrigues
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | | | | | | | - Simone Ramos Deconte
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil
| | - Daiana Silva Lopes
- Instituto de Genética e Bioquímica, Universidade Federal de Uberlândia, MG, Brasil
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7
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Nogueira LG, Frade AF, Ianni BM, Laugier L, Pissetti CW, Cabantous S, Baron M, de Lima Peixoto G, de Melo Borges A, Donadi E, Marin-Neto JA, Schmidt A, Dias F, Saba B, Wang HTL, Fragata A, Sampaio M, Hirata MH, Buck P, Mady C, Martinelli M, Lensi M, Siqueira SF, Pereira AC, Rodrigues V, Kalil J, Chevillard C, Cunha-Neto E. Functional IL18 polymorphism and susceptibility to Chronic Chagas Disease. Cytokine 2015; 73:79-83. [DOI: 10.1016/j.cyto.2015.01.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 01/09/2023]
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Cunha-Neto E, Chevillard C. Chagas disease cardiomyopathy: immunopathology and genetics. Mediators Inflamm 2014; 2014:683230. [PMID: 25210230 PMCID: PMC4152981 DOI: 10.1155/2014/683230] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023] Open
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is endemic in Latin America and affects ca. 10 million people worldwide. About 30% of Chagas disease patients develop chronic Chagas disease cardiomyopathy (CCC), a particularly lethal inflammatory cardiomyopathy that occurs decades after the initial infection, while most patients remain asymptomatic. Mortality rate is higher than that of noninflammatory cardiomyopathy. CCC heart lesions present a Th1 T-cell-rich myocarditis, with cardiomyocyte hypertrophy and prominent fibrosis. Data suggest that the myocarditis plays a major pathogenetic role in disease progression. Major unmet goals include the thorough understanding of disease pathogenesis and therapeutic targets and identification of prognostic genetic factors. Chagas disease thus remains a neglected disease, with no vaccines or antiparasitic drugs proven efficient in chronically infected adults, when most patients are diagnosed. Both familial aggregation of CCC cases and the fact that only 30% of infected patients develop CCC suggest there might be a genetic component to disease susceptibility. Moreover, previous case-control studies have identified some genes associated to human susceptibility to CCC. In this paper, we will review the immunopathogenesis and genetics of Chagas disease, highlighting studies that shed light on the differential progression of Chagas disease patients to CCC.
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Affiliation(s)
- Edecio Cunha-Neto
- Heart Institute (InCor), University of São Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9° Andar, 05406-000 São Paulo, SP, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, 05406-000 São Paulo, SP, Brazil
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9
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Frade AF, Pissetti CW, Ianni BM, Saba B, Lin-Wang HT, Nogueira LG, de Melo Borges A, Buck P, Dias F, Baron M, Ferreira LRP, Schmidt A, Marin-Neto JA, Hirata M, Sampaio M, Fragata A, Pereira AC, Donadi E, Kalil J, Rodrigues V, Cunha-Neto E, Chevillard C. Genetic susceptibility to Chagas disease cardiomyopathy: involvement of several genes of the innate immunity and chemokine-dependent migration pathways. BMC Infect Dis 2013; 13:587. [PMID: 24330528 PMCID: PMC3866603 DOI: 10.1186/1471-2334-13-587] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/04/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Chagas disease, caused by the protozoan Trypanosoma cruzi is endemic in Latin America. Thirty percent of infected individuals develop chronic Chagas cardiomyopathy (CCC), an inflammatory dilated cardiomyopathy that is, by far, the most important clinical consequence of T. cruzi infection. The others remain asymptomatic (ASY). A possible genetic component to disease progression was suggested by familial aggregation of cases and the association of markers of innate and adaptive immunity genes with CCC development. Migration of Th1-type T cells play a major role in myocardial damage. METHODS Our genetic analysis focused on CCR5, CCL2 and MAL/TIRAP genes. We used the Tag SNPs based approach, defined to catch all the genetic information from each gene. The study was conducted on a large Brazilian population including 315 CCC cases and 118 ASY subjects. RESULTS The CCL2rs2530797A/A and TIRAPrs8177376A/A were associated to an increase susceptibility whereas the CCR5rs3176763C/C genotype is associated to protection to CCC. These associations were confirmed when we restricted the analysis to severe CCC, characterized by a left ventricular ejection fraction under 40%. CONCLUSIONS Our data show that polymorphisms affecting key molecules involved in several immune parameters (innate immunity signal transduction and T cell/monocyte migration) play a role in genetic susceptibility to CCC development. This also points out to the multigenic character of CCC, each polymorphism imparting a small contribution. The identification of genetic markers for CCC will provide information for pathogenesis as well as therapeutic targets.
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Affiliation(s)
- Amanda Farage Frade
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
- Aix-Marseille Université, INSERM, GIMP UMR_S906, Faculté de médecine, 27 bd Jean Moulin, Marseille, cedex 05 13385, France
| | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro (UFTM), 40 Frei Paulino, Uberaba, MG 48036-180, Brazil
| | - Barbara Maria Ianni
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Bruno Saba
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Hui Tzu Lin-Wang
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Luciana Gabriel Nogueira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
| | - Ariana de Melo Borges
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro (UFTM), 40 Frei Paulino, Uberaba, MG 48036-180, Brazil
| | - Paula Buck
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Fabrício Dias
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - Monique Baron
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Ludmila Rodrigues Pinto Ferreira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Andre Schmidt
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - Mario Hirata
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Marcelo Sampaio
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Abílio Fragata
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Eduardo Donadi
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, SP 06504-000, Brazil
| | - Virmondes Rodrigues
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro (UFTM), 40 Frei Paulino, Uberaba, MG 48036-180, Brazil
| | - Edecio Cunha-Neto
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, SP 06504-000, Brazil
| | - Christophe Chevillard
- Aix-Marseille Université, INSERM, GIMP UMR_S906, Faculté de médecine, 27 bd Jean Moulin, Marseille, cedex 05 13385, France
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